SDCEP Prevention and Management of Dental Caries in Children Flashcards
Paeds SCR
What are the aims when providing dental care for children?
- safeguarding wellbeing of child
- prevent disease in primary/permanent dentition
- reduce risk of child experiencing pain/infection
-reducing risk of child developing treatment related anxiety
When should the first child dental assessment be?
Before the child is six months old
If you have concerns about dental compliance or attendance of a child, who should you contact?
- parent in first instance
- child’s health visitor
- school nurse
- GMP
- Childsmile dental health support worker
- social worker
What should the social history of a child include?
- which adults provide care for the child
- which days/times are easiest for the parent/carer to bring child
- name of medical practise they attend
- name of school/nursery attended
How can you help the younger child with an examination?
child sits on parents knee facing them & leans back onto dentists lap
What makes proximal caries detection in primary teeth difficult?
broad contact points of primary. dentition
What is the radiograph interval for children with high caries risk?
6-12 months
What is the radiograph interval for children with low caries risk?
2 years
What approach can you take if a child is very anxious/hesitant to get dental bitewings?
systemic desensitisation
What is MIH?
hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors
What does a plaque score of 10/10 indicate?
perfectly clean tooth
What does a plaque score of 8/10 indicate?
plaque line around cervical margin
What does a plaque score of 6/10 indicate?
plaque covering cervical third of crown
What does a plaque score of 4/10 indicate?
plaque covering middle third of crown
What factors are known to be associated with development of caries? (make up the caries risk assessment)
- clinical evidence of previous disease
- dietary habits (sugar)
- socioeconomic factors
- use of fluoride
- plaque control
- saliva
- medical history
What SIMD scores are indicative of disadvantage?
SIMD 1-3
Which children are more likely to have dental anxiety?
- children with high caries
- children with parents who have dental anxiety
What can be used to assess a childs dental anxiety level?
MCDASf
At what age can MCDAS be used?
8 years and older
What is the aim of behavioural management?
to promote a positive attitude to dental care & facilitate ongoing prevention and care
List some different behavioural management strategies to manage paediatric patients:
- Enhancing control
- Tell, show, do
- Behaviour shaping & positive reinforcement
- Structured time
- Distraction
- Relaxation
- Systemic desensitisation
What is the motivational interviewing approach?
SOARS
- seek permission
- open questions
- affirmations
- reflective listening
- summarising
How can you encourage toothbrushing habit formation?
- identify a convenient time and place for the preventive behaviour to occur eg after breakfast
- identify triggers eg putting on pyjamas
- review progress at followup appts
What evidence backs up toothbrushing with fluoride?
SIGN guideline 138
When do you use a smear of toothpaste?
under 3y/o
When do you use a pea-sized amount of toothpaste?
3 years & over
What toothpaste fluoride concentration should be used for standard prevention?
1000-1500ppmF
What toothpaste fluoride concentration should be used for enhanced prevention?
Under 10 = 1350-1500ppmF
Over 10 = 2800ppmF
How does enhanced prevention for children at increased caries risk differ from standard prevention?
- Provide standard toothbrushing prevention at EACH VISIT
- Hands on brushing instruction (3mins) AT EACH VISIT
- ## Consider use of high fluoridated toothpaste
In which children do we place fissure sealants?
ALL children (first permanent molars) as early as possible
At what age can you begin to place fluoride varnish?
2 years and over
What factors influence the optimal outcome of extraction of first permanent molars?
- Calcification of the bifurcation of the 7
- Presence of all second premolars and third molars
- Mild buccal segment crowding is present
- Class I incisor relationship
What non-caries removal technique can you use to manage proximal surface caries?
SEAL IT IN USING RESIN
- separate the teeth
- isolate the teeth with dam
- etch surface of tooth & rinse well
- apply resin sealant to the tooth surface to be sealed
- check no excess pooling around gingiva
- light cure and floss contact area
What is ART?
Atraumatic Restorative Technique
What caries treatment techniques are discussed in SDCEP paediatric document?
- site-specific prevention
- no caries removal & seal with fissure sealant/infiltration
- selective caries removal & restoration
- stepwise caries removal & restoration
- complete caries removal and restoration
- extraction
In which scenarios would you perform site-specific prevention?
- Initial proximal caries
- Initial anterior caries
In which scenarios would you perform no caries removal with fissure sealant/infiltration?
- Initial occlusal caries
- Initial proximal caries
In which scenarios would you perform selective caries removal and restoration?
- Moderate occlusal caries
- Moderate proximal caries
In which scenarios would you perform stepwise caries removal and restoration?
- Extensive occlusal caries
- Extensive proximal caries
In which scenarios would you perform complete caries removal & restoration?
- Moderate occlusal caries
- Moderate proximal caries
- Advanced anterior caries
When is site-specific prevention suitable?
- primary tooth with an initial lesion in occlusal/proximal surface
- primary anterior tooth with initial lesion
- primary tooth with arrested caries or when tooth close to exfoliation
- permanent tooth with initial lesion at proximal surface
- permanent anterior tooth with an initial lesion
What is the aim of site-specific prevention?
To stop enamel caries progressing and promote remineralisation of early lesions
What is involved in site-specific prevention?
- Show parent/carer & child the carious lesion
- Demonstrate effective brushing of the lesion
- Give dietary advice
- Apply fluoride varnish 4x a year
- Keep a record of the site and monitor it for plaque biofilm build up/progression
- If after 3 months active lesions are not arrested/showing signs or inactive lesions have become active consider alternative strategy
When deciding not to remove caries & seal them in, what can you use to seal?
- PMC (hall technique)
- BIS-GMA resin
- GIC
What is the aim of selective caries removal & restoration?
Remove sufficient carious tooth tissue to enable an effective marginal seal to be obtained with a bonded adhesive restorative material, inhibiting further progression of residual caries while minimising pulpal damage
What is involved in stepwise caries removal & restoration?
- Gain access & remove superficial caries
- Place a temporary bonded adhesive restoration
- This inhibits further progression of residual caries whilst allowed reactionary dentine to be laid down
- Stage 2 carries our 6-12 months later
- Access cavity and remove caries and final restoration
- Pulp will be further away from caries now
What LA techniques are useful in children?
- Intra-papillary injection (“chasing anaesthesia”)
- The Wand
What different dental services are available for children?
- GDPs
- PDS or Community Dental Service
- Hospital Dental Service
What children benefit from PDS?
- Pre-cooperative children
- Children with additional needs
- Children requiring sedation
What is the risk of death from GA for healthy children?
<1:100,000
What information should be included in a paediatric referral letter for dental care?
- Your details
- Pt details
- Pt C/O
- Clinicians concerns
- MH + DH + SH
- Summary of OH
- Details of request (eg advice only, care plan, tx)
- Enclosures such as radiographs/study models/photographs
What guidelines can you refer to for safeguarding/child protection?
- GDC standards for the dental team
- Child Protection Guidance for Health Professionals (from Scottish Gov)
- GIRFEC
What are the five key GIRFEC questions that practitioners need to ask?
- What is getting in the way of this child’s wellbeing?
- Do I have everything I need to help this child or young person?
- What can I do now to help this child or young person?
- What can my agency/profession do to help this child or young person?
- What additional help, if any, may be needed from others?
